Job Purpose

The Credentialing Specialist role is an integral part of PMC’s Telehealth division.  This position is responsible managing and coordinating all functions related to the credentialing and recredentialing of health care providers and maintains provider credentialing files.

Duties and Responsibilities

The Credentialing Specialist duties shall include, but not be limited to, the following as it supports PMC’s 3Cs Mission of: 

• Care – Provide the best possible patient care 
• Compliance – Ensure the program operates within all regulations 
• Community – Become a wonderful addition to your local community

• Maintain physician and facility records by organizing and updating files while keeping both parties up to date with the most recent documents.
• Provide physicians with materials needed for licensing and guide them through the process
• Credentialing physicians with facilities and payers by communicating and exchanging required information.
• Prepares and monitors timeline reports for physician licensing and credentialing.        
• Enhances physicians experience by being their documentation expert from start to finish.
• Updates job knowledge by participating in educational opportunities.
• Answers and delegate incoming calls and messages related to credentialing, licensing, and physician records
• Build and establish relationships with state licensing boards, credentialing agencies, and managed care organizations
• Continuously evaluate current processes looking for more efficient solutions
• Receives and processes all initial credentialing and recredentialing applications.
• Collects all pertinent information from the provider, provider’s malpractice insurer, National Practitioner Data Bank (NPDB) and other sources as deemed appropriate.
• Ensures that credentialing and recredentialing of providers occurs on a timely basis in accordance with industry and company standards and criteria.
• Maintains accurate and complete records of each application’s status.
• Enters all provider information into database.
• Prepares all documents to be reviewed by management and/or client credentialing partners.        
• Attends Credentialing related meetings as necessary.
• Maintains all credentialing and recredentialing timelines and schedules.
• Maintains strict level of confidentiality on all matters pertaining to provider.
• Maintains well-organized provider files that are easily reviewed by management or client providers, outside review bodies, and others.
• Processes approval, denial, or termination communications with providers and/or clients.  
• Performs other related duties as assigned by management.
• Keep current on practice management trends and matters.

Qualifications

• Education: HS Diploma or GED required.  Bachelors Degree preferred. 
• Experience: 1-2 years of related experience preferred
• Commitment to excellence and high standards
• Excellent written and oral communication skills
• Ability to manage priorities and workflow
• Versatility, flexibility, and a willingness to work within constantly changing priorities with enthusiasm
• Ability to work independently and as a member of various teams and committees
• Ability to understand and follow written and verbal instructions.
• Acute attention to detail
• Demonstrated ability to plan and organize projects
• Able to work collaboratively with multiple health professionals in a busy and complex environment using tact, diplomacy, and discipline.
• Ability to communicate professionally and effectively in person, on the phone, electronically, or through other means to individuals and groups.
• Excellent customer service skills. 

Working Conditions

This job works in a professional office environment.  

Physical Requirements

While performing the duties of this job, the employee is regularly required to talk and hear. Specific vision abilities required by this job include close vision, distance vision, color vision, peripheral vision, depth perception and ability to adjust focus.  

Direct Reports

This position does not have direct reports.  

Reporting Structure

The Credentialing Specialist position reports directly to the Operations Manager, Telehealth Services.